Binge eating connected to obesity, purging linked to substance abuse.

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MONDAY, July 16, 2012 (MedPage Today)
— Adolescent girls with a variety of eating disorders —
even conditions less severe than anorexia or bulimia — are at risk
for obesity and alcohol and drug use, a prospective study found.

Among those who reported binge eating but not purging, the risk for
becoming overweight or obese was doubled compared with healthy peers, according
to Alison E. Field, ScD, of Harvard University in Boston, and
colleagues.

Similarly, teenage girls who purged more than once each week even
without binge eating were at risk for starting to use drugs or to overuse
alcohol frequently, the researchers reported online ahead of print in the
August issue of Pediatrics.

The true prevalence of eating disorders has been uncertain, since it
has become increasingly apparent that many affected individuals do not meet the
criteria specified in the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV).

The outcomes associated with these subthreshold eating disorders also
have been unclear, so Field and colleagues recruited 8,594 girls whose mean age
was 12 and who replied to serial questionnaires beginning in 1996 on eating
habits and related concerns.

Approximately 4.1 percent reported binge eating more than once weekly,
another 4.1 percent purged more than once weekly, and 1.5 percent were
classified as having bulimia nervosa, characterized by both binge eating and
purging at least once each week.

By 2007, 19.8 percent of the participants had become overweight or
obese, 27.4 percent reported high levels of depressive symptoms, 36.3 percent
were binge drinking, and 24.9 percent were using drugs other than
marijuana.

Girls who reported binge eating more than once weekly were at risk for
having high levels of depressive symptoms.

Those with bulimia nervosa were almost four times as likely to be
using drugs compared with unaffected adolescent girls.

Even those classified as "eating disorder not otherwise
specified," who overate weekly but did not sense "a loss of
control," were at risk for drug use and binge drinking.

The researchers also analyzed outcomes when the disordered eating
behaviors were reported as occurring monthly, rather than weekly, and again
found high rates of adverse outcomes.

For example, those who reported bulimia nervosa on a monthly basis
still were more than three times as likely to have started using drugs, while
those who reported monthly binge eating were at risk for having high levels of
depressive symptoms.

In addition, an increased risk for overweight or obesity was found for
among girls who purged monthly and for those with monthly binge
eating.

In discussing their findings, the researchers noted that the DSM-IV
does not classify purging disorder or binge eating disorders as distinct
diagnostic entities.

According to those current criteria, only 2 percent of adolescent
girls and young women would be classified as having an eating disorder, which
overlooks the sizable group who have subthreshold symptoms.

"The underestimation is even more striking if we include [eating
disorder not otherwise specified], which increases the prevalence of eating
disorders to 13 percent to 21 percent among adolescent and young adult
females," observed Field and colleagues.

They also noted that the upcoming revision of the DSM is expected to
include binge eating disorder, but not purging disorder, as a diagnostic
classification.

Yet the risks of adverse physical and psychological outcomes were
similar in this cohort for those who purged, they cautioned.

These conditions should be acknowledged as specific categories of
disease, rather than being relegated to the "heterogeneous and often
overlooked" group referred to as "eating disorder not otherwise
specified," they argued.

"Primary care clinicians need to be made aware of these disorders
so that adolescents in need of treatment will be identified," they concluded.

Limitations of the study included the predominantly white population
and self-report of eating behaviors.

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